Shipping Address -	Billing Address -	Paplin Products, LLC
Name ________________________	Name ________________________	Fax Order Form
Address ______________________	Address ______________________	Fax To 440-572-1207
______________________________	______________________________
City _________________________	City _________________________
State ________ Zip Code ________	State ________ Zip Code ________
Phone No. ____________________	Phone No. ____________________
Item Number	Description	Quantity	Price
		Total
Accepted Credit Cards - Visa / Mastercard / Discover
Credit Card Number	Expire Date	CVV Code
______________________________	______________________________	__________
*CVV - The CVV code is the last 3 digits on the reverse side of your card.  It ascertains that the customer
placing the order acutally possesses the credit/debit card and that the card is legitimate.
Make sure you fill out all fields needed, including your Name & Phone Number.  If an item is out of stock,
we will contact you via the telephone number provided.  All orders are shipped F.O.B.